Depression, Postpartum, Perinatal Depression
Conditions
Keywords
Perinatal depression, Perinatal anxiety, perinatal mental health conditions, electronic CBT, CBT, task shifting, low-resourced settings, task sharing, Thinking Healthy Programme, LMIC, Technology-assisted, peers, community health workers
Brief summary
Background The Thinking Healthy Program (THP) is an evidence based task-shifted low intensity psychosocial intervention, recommended by the World Health Organization for the treatment of perinatal depression. The investigators developed a technology-assisted version of Thinking Healthy Program (THP-TA) which allows peers to deliver the THP, while ensuring minimal resources for training of delivery agents and ensuring adequate fidelity. Method This is a non-inferiority, pragmatic cluster randomized controlled trial designed to test the primary hypothesis that technology assisted delivery of THP is not worse than THP intervention delivered by community health workers, in increasing perinatal depression remission rates at 3 months postnatal. In addition, this study will also test the effectiveness of the THP-TA in improving recovery from perinatal depression at 6 months postpartum, quality of life and social support. This study also aims to evaluate the cost-effectiveness of the THP-TA.
Interventions
BEHAVIORALTechnology assisted Thinking Healthy Program (THP-TA)
A technology adapted version of the Thinking Healthy Program (THP) delivered by peers using multimedia android based app.
BEHAVIORALStandard Thinking Healthy Program
This intervention paper-based manual delivered by lady health workers ie government employed community health workers with health training background.
Sponsors
Shifa Tameer-e-Millat University
University of Liverpool
Human Development Research Foundation, Pakistan
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Pregnant women with current major depressive episode in their second or third trimester (4 to 8 months of pregnancy). 2. Aged 18 years and above 3. Intent to stay in the study area for at least 1 year.
Exclusion criteria
1. Women requiring inpatient care for any reason (medical or psychiatric) as determined by their primary health care professional 2. Those who do not comprehend Urdu language will be excluded.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Remission rates of perinatal depression | 3 months postnatal | Remission rates from perinatal depression among the trial participants will be based on clinical diagnostic criteria based on the Structured Clinical Interview for the DSM-IV Axis (SCID) module. The SCID will be employed at baseline and 3 months postnatal. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in severity of perinatal depressive symptoms | 3 months and 6 months postnatal | Severity of perinatal depressive symptoms will be measured using the Patient Health Questionnaire-9 items assessed at baseline, 3 months and 6 months postnatal. Score on this scale ranges from 0 to 27, with higher scores indicating increased severity. |
| Change in severity of perinatal anxiety symptoms | 3 months and 6 months postnatal | Severity of perinatal anxiety symptoms will be measured using the Generalized anxiety Disorder-7 scale assessed at baseline, 3 months and 6 months postnatal. Score on this scale ranges from 0 to 21, with higher scores indicating increased severity. |
| Change in maternal Quality of Life | 3 months and 6 months postnatal | Change in maternal quality of life will be measured using the EuroQuality of Life scale (EQ-5D-3L), at baseline, 3 months and 6 months postnatal. It is a valid and reliable scale to quantify health status across 5 dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. |
| Change in disability using the World Health Organization Disability Assessment Schedule 2.0 | 3 months and 6 months postnatal | This World Health Organization Disability Assessment Schedule 2.0 questionnaire assesses disability due to health conditions or illnesses (chronic or acute) including mental and emotional health problems. It is a valid and reliable instrument that generates domain-specific scores for six different functioning domains: i) cognition ii) mobility iii) self-care iv) getting along v) life activities (household and work/school) and vi) participation. It will be employed at baseline, 3 and 6 months postnatal. |
| Service use and costs | Pregnancy through to 6 months postnatal | Service use will be measured using Client Service Receipt Inventory (CSRI), including costs of healthcare services used, details and costs of medications and wider health service utilization and economic costs at 3 months and 6 months postnatal. |
| Infant nutrition/breastfeeding | 3 months and 6 months postnatal | Using 24-hour recall WHO breastfeeding practices tool, we will quantify percentage of infants being exclusively breastfed at 3 months and 6 months postnatal. |
| Sustained remission rates of perinatal depression | 3 months and 6 months postnatal | Sustained remission rates from perinatal depression among the trial participants will be based on clinical diagnostic criteria based on the Structured Clinical Interview for the DSM-IV Axis (SCID) module, assessed at baseline, 3 and 6 months postnatal. |
| Infant Immunization Status | 3 months and 6 months postnatal | Immunization status of the infant will be assessed using a categorical question assessing completely or incompletely immunized as per the Expanded Programme on Immunization program in Pakistan, at 3 months and 6 months postnatal. |
| Maternal Social support | 3 months and 6 months postnatal | Multidimensional Scale of Perceived Social Support (MSPSS) will be used to assess the perceived levels of social support among the intervention recipients at baseline, 3 months and 6 months postnatal, from three sources: family, friends and significant other. It comprises of 12 items, scores on which can be summed together with higher scores corresponding to better social support. |
| Parental time spent in play with the infant | 3 months and 6 months postnatal | Parental time spent in play with the infant will be assessed at 3 months and 6 months postnatal. |
| Diarrheal episodes among infants | 3 months and 6 months postnatal | Number of episodes of diarrheal episodes among infants will be assessed using the WHO criteria and definitions, at 3 months and 6 months postnatal |
| Acute upper respiratory tract infections among infants | 3 months and 6 months postnatal | Number of episodes of acute upper respiratory tract infections among infants will be assessed using the WHO criteria and definitions, at 3 months and 6 months postnatal |
| Family planning practices | 3 months and 6 months postnatal | To ascertain family planning practices, categorical questions will be asked regarding the use of contraception during the postpartum period. |
Countries
Pakistan
Outcome results
None listed